Pain Assessment

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By Michael Gilles, MS, RN, AGCNS-BC and Diana Goettemoeller MS, RN, ACNS-BC, CCRN

One of the most important nursing functions that we provide for our patients is the assessment and management of their pain. A large study of patients across various hospital settings showed that clinically significant pain was present in 40 percent to 50 percent of patients (Carr, 2013). A survey conducted by the Joint Commission in 2010 revealed that a topmost challenge in pain management was a lack of measurement instruments to document pain. Documentation tools reflect the state of our nursing practice (Lauwers, 2010). A new comfort management/pain hierarchy group in EPIC has been designed to provide a guide for pain assessment approaches, particularly for patients unable to self-report pain.

Have you ever felt uncertain when trying to assess pain in the non-verbal patient? You are certainly not alone in this! The new comfort management flowsheet is intended as a support to the clinician who wishes to assess pain in an individualized fashion. The new flowsheet has been developed out of the evidence-based concept of the pain assessment hierarchy. The hierarchy maintains that the patient’s verbal report is the gold standard pain assessment tool; however, recognizing that this is not an option with all patients, it allows us to effectively assess pain in non-verbal patients (Herr, 2013). When used properly, the flowsheet will guide the clinician through the pain hierarchy and lead to accurate assessment and safe, adequate treatment of pain. Developmentally appropriate tools, such as FLACC, have been added to better assess the broad range of patients we see. Additionally, the “critical care pain observation tool” (CPOT) has been added to better assess our non-verbal patients in the critical care setting.

In the future, additional pain assessment tools will be added to address the specific needs and characteristics of our patients. Watch for Epic Tip Sheets and a HealthStream education module that will provide further information on this exciting new clinical tool! Your system shared governance council members and clinical nurse educators have been briefed on this as well and can provide you support in navigating the flowsheet. We are excited about the opportunity that this improved clinical support tool provides to all of our great clinicians who strive every day to provide excellent care to their patients.

Carr, E. et al. (2013). Pain: A quality of care issue during patients’ admission to hospital. Journal of Advanced Nursing, 71(6), 1391-1403.

Herr, K., Coyne, P., McCaffery, M., Manworren R., & Merkel S. (2011). Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations. Pain Management Nursing, 12(4), 230-250.

Lauwers, K., & Whitehurst, S. (2012). Pain management: A systems approach to improving quality and safety. Oakbrook Terrace, Ill: The Joint Commission on Accreditation of Healthcare Organizations

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